Banatvala, N.Wyss, K.Akweongo, P.et al.2023-09-272023-09-272023DOI: 10.4324/9781003306689-43http://ugspace.ug.edu.gh:8080/handle/123456789/40160Research ArticleUniversal health coverage (UHC) is a central part of the 2030 Sustainable Development Agenda and the WHO Global NCD Action Plan. Achieving UHC means that all people would have access to the health services they need, when and where they need them, without financial hardship. UHC includes health protection and promotion, as well as disease prevention, treatment, rehabilitation and palliative care, across the life-course.1 There will always be trade-offs in allocating resources between each of the UHC dimensions (i.e. population covered, services provided, and direct costs to patients) (Figure 38.1). What levels of coverage can be provided for the population? Or should more services be covered by enlarging the benefits package to include other health services and if so which ones? Or should cost sharing and fees for patients be reduced? In addressing these questions, it is clear that UHC is more of a political than a technical construct, with governments having to make decisions and trade-offs across: (i) levels of taxation on income, salaries and goods, and levels of public sector financing to improve access to healthcare, promote population health, and more broadly improve social determinants of health (e.g. education, housing and social care – Chapter 17); (ii) the responsibility of government and the individual in accessing and financing the costs of healthcare, includ ing the acceptable level of household out-of-pocket (OOP) expenditure (e.g. cost-sharing, self-medication and other expenses paid directly by households to the health provider) and the importance attached to preventing people from going into debt and as a result experiencing poverty and/or catastrophic health expenditure; and (iii) issues around levels of healthcare afforded to groups and communities that are marginalized or suffer from discrimination. UHC poses important governance challenges,2 including making decisions around health equity, social cohesion, the efficiency of resource allocation and sustainable human and economic development.3 In this sense, the path to achieving UHC has been viewed as a political struggle and is not value-free.4 The political importance of UHC was highlighted in 2019 when world lead ers committed to ensuring UHC (including for the prevention and control of NCDs) was available in their countries.5 An effective health financing system is essential to achieve UHC. This con sists of: (i) raising sufficient funding to cover the costs of the health system; (ii) pooling resources to protect people from the financial consequences of ill health; and (iii) purchasing or providing health services to ensure greater efficiency in the allocation of available resources. Most healthcare financing schemes receive transfers from the government, social insurance contributions, voluntary or compulsory prepayments (such as insurance premiums), other domestic revenues, and revenues from abroad (for example, as part of development aid and remittances). Chapter 39 provides more detail on financing for NCDs.enUniversal health coverageAgendarehabilitation and palliative careArticle